Postherpetic Neuralgia

What is Postherpetic Neuralgia?

Postherpetic neuralgia is ​a complication of shingles. A case of shingles will typically only last a few weeks. If pain remains after the blisters and skin irritations subside, postherpetic neuralgia may be diagnosed. Early treatment of shingles can reduce the risk of developing postherpetic neuralgia. 

Nerve fibres in the skin can be damaged during an outbreak of shingles, and the virus may remain resident in the nerve cell. When this happens, the nerves in the skin cannot communicate properly with the brain, resulting in postherpetic neuralgia.  

What are the symptoms?

Symptoms for postherpetic neuralgia present in the distribution of  the nerve affected by the shingles. Individuals may experience a burning, sharp pain and a sensitivity to light touch (which may even include the touch of clothing against the skin). Less commonly, patients may experience a numb or itchy feeling in the affected areas, and in some cases, muscle weakness or paralysis.  

Is there any treatment?

Often a combination of different treatments are used to manage postherpetic neuralgia and any associated pain. Treatments include the use of topical medicines applied to the skin itself, such as lidocaine and capsaicin skin patches; as well as medicines taken by mouth such as anticonvulsants, antidepressants and opioid painkillers.  

What is the prognosis?

Most individuals suffering from postherpetic neuralgia will experience a slow improvement of pain symptoms with treatment.

Related evidence

Markley HG, Dunteman ED, Sweeney M. Real-World Experience with Once-Daily Gabapentin for the Treatment of Postherpetic Neuralgia (PHN). Clin J Pain. 2014 Jul 28. [Epub ahead of print]

Schlereth T, Heiland A, Breimhorst M, Féchir M, Kern U, Magerl W, Birklein F. Association between pain, central sensitization and anxiety in postherpetic neuralgia. Eur J Pain. 2014 Jul 28. doi: 10.1002/ejp.537. [Epub ahead of print]